A pair of massive new complexes grace the Dallas Medical District: the new Parkland Memorial Hospital (left), which opens in August and UT Southwestern’s Clements University Hospital (right), which opened in December.

ARCHITECTURE REVIEW

Growing pains at new Dallas hospitals

Modern new Parkland, UTSW buildings lack human touch

Antiseptic. Clinical. Sterile. It is no coincidence that the words we use to describe the places we find least comforting are also the conditions required of the spaces in which we seek medical treatment.

To put it more acutely, the environments designed to make us feel better often make us feel worse. The experience of industrialized modern medicine, with its pinging machines and sharp edges, can strip us of our humanity and elicit a profound sense of anxiety. This presents architects with a difficult challenge: reassuring us that we are receiving the most advanced treatments, but doing so in spaces that enhance rather than compromise our dignity.

The actual correlation between health care outcomes and design is difficult to track, though an entire field has developed within the architectural profession devoted to improving patient satisfaction and medical performance. Its presumptions are that design that provides access to nature, that is sympathetic to the body in material and color, and that is intuitive in its organization will alleviate stress, minimize clinical errors and result in faster and more successful recoveries. Good, or luxurious, design is also good business, a way of luring the wealthy and well-insured patients hospitals crave.

Meeting this demand, however, has proven to be a task with all the complexity of microneurosurgery, as illustrated by a pair of massive new Dallas Medical District complexes: the new Parkland Memorial Hospital, which opens in August, and UT Southwestern’s Clements University Hospital, which opened in December. The facilities for these at once competitive and mutually dependent institutions cost in excess of $2 billion and combine to represent both the best intentions of contemporary health care design and also some of its continuing weaknesses.

The uneasy relationship between the two hospitals is reflected in their proximity — or lack thereof. The two public institutions have been partnered since 1943, with UTSW providing practitioners to Parkland and Parkland in return serving as a training ground for doctors from UTSW. Yet the two facilities are located so far from each other within the Medical District that walking between them is not a realistic option.

Parkland, if nothing else, is hard to miss: Its reflective aluminum bulk seems visible from nearly all quarters of the city, looking like nothing so much as some mythical giant’s collapsed Jenga tower. In fact, it is a highly considered composition of metallic bars stacked and cantilevered across one another at perpendicular angles, designed as a joint venture by the Dallas architecture firms HDR and Corgan. The 2.8 million-square-foot campus boasts 862 patient rooms, 154 emergency treatment rooms, 44 labor and delivery rooms, 27 surgical suites and a garage with 6,000 parking spaces.

Those numbers suggest an overwhelming scale, and indeed that is Parkland’s fundamental problem. Parkland’s board had, in fact, considered the idea of building a smaller central hospital with several satellite inpatient facilities, thereby bringing Dallas County’s principal public hospital system more directly to the population it is intended to serve. That plan was rejected under pressure from administrators at UTSW, who feared it would complicate staffing arrangements and compromise care.

A memorial to President John F. Kennedy and Lyndon Johnson was moved from the old hospital to the new $1.3 billion Parkland Memorial Hospital.

Medical monument

The result is a massive complex that draws patients from across the county. For those who drive, this means navigating a garage that would be at home in a sci-fi film — it is delineated by lines of black glass and white concrete — and then walking across open ground to the hospital proper. Public transit commuters are also exposed to the elements on a long walk from bus and rail stop.

No matter the means of arrival, visitors find themselves before a colossal medical machine. “The thing about it that I like the most is that most people would think it’s an office building, not a hospital,” a Parkland executive, Lou Saksen, told me on a recent tour. “It makes a very strong sculptural statement.”

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It is a statement that suggests just how sadly ingrained Dallas’ corporate culture has become in the city’s design consciousness. An office building? Surely a better model would be a resort hotel. At the very moment patients should be reassured they will be greeted and cared for as individuals, the new Parkland instead offers grids of identical square windows set in burnished aluminum panels that become progressively lighter as they rise toward the sky. As sculpture it is bold, but as architecture it is alienating.

Things improve dramatically in the lobby, a limpid double-height space with handsome terrazzo floors, calming slate walls and detailing in a warm blond pecan wood. A tasteful display adjacent to the waiting area acts as both a historical marker and memorial to John F. Kennedy, who will forever be the hospital’s most famous patient. The pleasant light is filtered through windows etched with the names of Dallas County residents who responded to a mass mailing asking for a $10 donation. From afar, the names dissolve into floral patterns in the glass; a handsome effect that speaks to the philanthropic nature of the entire city, not just its wealthiest citizens.

Sunlight streams through the east windows of the Parkland lobby.

The lobby serves what are essentially two different hospitals: a 17-story acute care center and a nine-story facility for women and infants that crosses underneath it. Parkland administrators wanted them effectively separated, which accounts for their perpendicular orientation. The design allows the facilities to share a main lobby and mechanical cores.

If this seems logical on paper, it too often becomes disorienting when one is actually in the bowels of this complex beast. Patients, and perhaps employees, will find it easy to get lost, to get turned around, to end up going in the wrong direction. The color scheme, lots of beige with pale blue and avocado accents and almost no natural materials, is the depressing product of group-think. In an effort to be a conscientious citizen, Parkland engaged a community advisory group to help choose the colors, instead of leaving that job to to professional designers, who might have thought more creatively.

The design failure is perhaps most egregious in the preoperative rooms, where patients are prepped for surgery and presumably asked to put signature to the hospital’s liability forms. Here, where patients are at their most vulnerable, Parkland has presented them with the most depressing tableau imaginable: a beige wall with a sad little landscape print that is intended to be soothing but instead merely reinforces a sense of removal and isolation.

Parkland’s patient rooms awkwardly place the bathrooms along the outer wall, cutting into the view from the window.

All private rooms

Patient rooms are more humane, if imperfect, their most significant features being that every one, as at Clements, is private and that every one has a view toward the city through one of the large, square windows that mark the exterior. The flooring is a pleasant vinyl faux wood, and rooms are each equipped with a sofa that pulls out into a queen-size bed. The layout is awkward, however: The bathrooms, purchased as prefabricated units, have been inserted on the window side, which means that the bed must be set far from the view and that anyone sitting on the sofa in the cove-like space in front of that window is in perpetual silhouette during the day.

It is instructive to compare these patient rooms with those at Clements, which was designed by the Dallas office of the firm RTKL. Here, almost identical prefabricated bathrooms are set along the corridor wall, allowing the bed to be placed closer to a broad window. Both have nurses’ stations set just outside of each room, with windows, operable from inside and out, that allow for the monitoring of patients without disturbance.

The Clements patient rooms, all of which are private, come close to being resort-like.

Between the two, Clements comes closest to achieving something close to the luxury resort paradigm. Public spaces at the hospital are enhanced by a sophisticated art program, with abstract works including an installation of hanging white squares by Spencer Finch that activates the building’s central atrium, an otherwise cold space with an enormous glass window wall.

The patient floors reinforce a sense of hospitality, with waiting spaces arrayed along open terraces looking over the atrium. Seen from above, these floors form a broad W, which allows a single information station (at the bottom of each “V”) to act as the entry for two wings. The materials are muted, with warm woods offsetting the cool white and black spaces of principal public spaces.

What may be most remarkable about Clements is what is absent: noise. Even running at full capacity, the patient wards are notably quiet, a product of efficient organization and a pneumatic mechanical system that delivers laundry, medicines, test samples and other materials, thereby keeping service operations to a minimum. Parkland, it should be said, takes advantage of many of these same systems.

The greeting desk on the sixth floor is indicative of the clean-lines appearance at Clements.

Clean lines at Clements

Clinical areas at Clements are visually cleaner than those at Parkland: white and bright, with clear circulation paths. If these environments are not particularly endearing, they should at least evince a sense of confidence and calm during stressful moments.

The exterior, however, is no more appealing than Parkland’s, which at least makes for a coherent sculptural statement. Clements, instead, is a generic assemblage of black glass framed in white concrete bands, the whole undermined by signage so garish it would make Donald Trump blanch. As at Parkland, visitors arriving by car will be expected to brave the elements on a path from garage to hospital, a less than ideal scenario in inclement or hot weather.

Both hospitals will be fronted by gardens, neither yet complete, that will introduce a welcome dose of nature to their respective architectural compositions. Yet it is telling that these landscapes exist at a remove from the hermetic hospital environments, which are absent internal courtyards.

Technology, as these facilities suggest, can be a double-edged sword. Video conferencing will eventually allow patients to interact with far-off family and friends, as well as letting doctors check in without actually having to spend time at the side of the bed. That may keep costs down, but is that what’s best for patients?

But there is only so much technology can do. For better and worse, we’re stuck with the often ugly reality of our mortality, and that is why the spaces in which we confront it should be as humane as possible. Too often, they’re not.

Mark Lamster is a professor at the University of Texas at Arlington School of Architecture.

The main lobby atrium of the Clements Hospital is deorated with Spencer Fitch's Optical Cloud.

The third floor waiting area at Clements.

Patient rooms line the 13th floor hallway at Parkland.

Patterns in the lobby window, when viewed up close, are composed of the names of Dallas residents who donated to the construction of the Parkland.